{Click on title to read paper] Orthodontic Jaw Wiring: The Dental Professional's Role in Weight Control for Compulsive Overeating Leading to Obesity

Presented to the American Association of Orthodontists at the 110^th meeting held in Washington DC, May 3, 2010

Speaker: Ted Rothstein, DDS, PhD, Life-active member AAO, Brooklyn, NY, www.drted.com, drted35@aol.com

 [Below click on link to view the Power Point Presentation]

AAO OJW PPP.ppt

Welcome colleagues.  I'm Ted Rothstein.  I am a life-active member of the AAO.  I live and practice in Brooklyn NY.

Thank you for attending my presentation on this hitherto never-addressed and highly controversial subject: Orthodontic Jaw Wiring for the control of compulsive overeating-- or simply O-J-W.  OJW is a TREATMENT MODALITY for a serious widespread social, psychological and physiologic problem that can help CAREFULLY SELECTED patients who are obese, or who are heading towards obesity, to start regaining control over their compulsive eating habits, with their potentially grave consequences. OJW at the outset may seem extreme, however when safety, effectiveness and side-effects are considered it will be shown to be a benign, non invasive, conservative alternative approach to weight control 

Having provided this service for the past 10 years I will testify that OJW is safe and effective when performed under the protocol I will present. Under this protocol the doctor is responsible for maintaining the health of the TMJ, Dentition and Gingiva. It is the PATIENT who is responsible for losing weight by dint of their passionate dedication and adherence to a long-term, low-calorie liquid diet.

Again, thank you again for attending and I welcome your attention.

ORTHODONTIC JAW WIRING  refers to the entire domain of the OJW provider's responsibility  for selecting patients according to a specified criteria, providing them with informed consent so that they are aware of the risks and limitations of OJW, then wiring their jaws (see also) (see also) together by a prescribed, method, transmitting that know-how to the patient (especially if they are not able to return to your office and can not find a professional level provider) and finally, reexamining them and rewiring them periodically after examination has shown that their dentition, gingiva, and TMJ have remained healthy until the period of time that they have elected to receive OJW expires (usually about 6-9 months; representing a weight loss of  50-75 pounds) and you have removed the wiring and brackets. OJW presumes that the service is provided under the auspices of a healthcare team which includes: the patient's physician and dentist, the provider of the OJW service, a dietician, and when applicable the patient's psychologist and/or psychotherapist as well as the input of a bariatric surgeon .

PROTOCOL: Jaws are wired APART 2.0 mm-4.0 mm and released every five weeks for five days to permit TMJ to recover from any loss of mobility.
THE OJW POSITION OF PHYSIOLOGIC REST is a parted resting position of the mandible at which the muscles of mastication are in a minimally contracted position thereby allowing the lower jaw to be suspended from the maxillary teeth in a condition of "weightlessness". Inter-occlusal wiring permits the mandible to move  2.0 mm - 4.0 mm laterally, vertically and antero-posteriorly  thereby minimally impeding speech and minimizing the possibility of TMJ stiffening. This position is often congruent with an observable inter-occlusal space of 2.0 mm - 4.0 mm and closely approximates the position we know as the "physiologic jaw resting" position, the initial position  from which all jaw excursions begin. It is this condition of  jaw "weightlessness" that precludes the possibility that the upper/lower teeth are extruded during the time the OJW device is in place.

CANDIDATES FOR OJW: Persons 21 and 45 whose Body Mass Index (BMI) ranges between 27-37 (Overweight-->Obese).
POOR CANDIDATES FOR OJW
a. Persons who are accustomed to floss their teeth daily.
b. Persons who speak abundantly for business or other reasons whose speech might be rendered less than perfectly clear because of being wired closed.
c. Persons whose sex life would be rendered intolerable if intimate oral functions were impaired…even a little.
d. Persons with multiple-missing, loose or decayed teeth
e. Those with psychological or emotional disorders who might feel powerless/ panicky with their mouths wired closed.
f. Those whose work functions might be impaired such as an actor, singer, waiter, teacher etc.
g. Persons with systemic diseases such as diabetics whose diets could not accommodate a liquid diet.
h. Persons who cannot breathe through their nose and whose breathing might be compromised by being held continuously in a closed bite teeth position.
i. Those who are highly allergic are more at risk.
j. Persons who have respiratory ailments such as snoring and/or sleep apnea as well as those who must use a broncho-dilator spray such as asthmatics.
k. Persons who have a history of Temporo-Mandibular Joint dysfunction, although OJW might in some cases be palliative.
l. Persons who are taking oral pill/capsule form medications could encounter some difficulties trying to pass a large capsule into the mouth behind the last teeth. It would be virtually impossible if the wisdom teeth were fully in place.
m. Persons who compulsively clench/brux/gnash their teeth.
n. Persons who have, or are suspected of having, anorexia or bulemia to begin with.
o. Persons with frank unresolved periodontal (gum-tooth socket) problems.
p. Persons who drink alcoholic beverages. (Alcohol suppresses the gag reflex). In the event of alcoholic intoxication vomiting can occur.

q. Persons who:  1. will not provide a telephone number 2. do not have an Email address. 3. are below the age of 21 unless accompanied by a parent. 4. are more than 100 pounds overweight or less than 25 pounds overweight (i.e moderately obese and obese, but not "morbidly" obese). In brief, persons whose BMI varies between 27-37.
OJW INFORMED CONSENT
DIRECTIONS:
Carefully read the Informed Consent then fill in the data requested (* information requested is mandatory). Place your initials/name in all places requested and email the Informed Consent to drted35@aol.com. Then just below see hyperlinks to the "Adult Acquaintance" and  "Adult Medical History" forms. Download and complete BOTH  forms and mail or fax them  to the office (fax 718 852 1894 evening best).  When I have received ALL THREE FORMS  I will call you without further delay.
* Date:    /    / 2005 6 7       * Name:                         * Age:     Date of birth:     * Height:          
* Present Weight:                               * Goal Weight:          (click on link)--->*Present Body Mass Index (BMI):  
* Activity Level  (Life style): (Circle one) inactive, mildly a., moderately a., very active  
*Number of months you are initially willing to dedicate passionately to the jaw wiring (OJW) approach to weight loss:  2 3 4 5 6 (3 months/ 21 pounds, assuming 5 pounds first week then 1.5 pounds each week thereafter)
*Address:                        *City:              *State:       * Zip:
*Occupation:
*Home Telephone:                 *and Work Telephone (Other):                 * and Cell/ Mobile Telephone:
 *Email Address:  Dr. Rothstein will not contact you if you not provide a working email address.
* Your dentist's name:
   Address:
  * Telephone number:
   I give Dr. Ted my permission to call my dentist by placing my initials here  X_______.
*You physician's name:
   Address:
   *Telephone number:
 * I give Dr. Ted my permission to call my physician by placing my initials here  X_______.
Please complete both forms indicated below and FAX to my office: 718 852 1894.  After I review the data from ALL THREE FORMS I will call you to discuss your goals and help you arrange an appointment.  With few exceptions OJW appointments are most often seen at noon on Thursdays.
                       (DOWNLOAD ADULT ACQUAINTANCE FORM)                (DOWNLOAD THE ADULT MEDICAL HISTORY FORM)
     I, X_________________________, authorize Dr. Rothstein to wire my jaws into the OJW position of rest. I realize that I will need to be on a low calorie liquid diet to achieve my weight loss goal.*  I know I can have the  orthodontic jaw wiring (brackets and wire) removed at any time I request. I have read and I understand all the material on Dr. Rothstein’s web site related to the orthodontic jaw wiring procedure. I also recognize that even if I achieve my weight loss goal, I may well regain the weight. I have been advised that the best way to maintain the weight loss is be means of life style changes, which include a low calorie, balanced diet matched to an appropriate exercise regime for my life style.
     I am at liberty to review the results of the survey Dr. Rothstein completed in January of 2009 to see how other OJW patients fared.  View the benefits and problems of OJW.
     I understand that Dr. Rothstein requires a note from my physician indicating that I have no medical conditions that will cause me any problems if I begin a weight- loss program based on a liquid diet. The purpose of such a note is to rule out for your own safety and my assurance that such a diet would not be harmful to you. Such a letter has only to say: "[Name of Patient] has no gastro-intestinal issues or other medical problems that would contra-indicate a liquid diet". I take such a note to mean that you have no medical problems that a prolonged liquid diet would make worse. Lacking this note Dr. Rothstein can not provide OJW.
     Dr. Rothstein’s work shall be largely limited to placement and removal of the orthodontic jaw wiring appliance as a whole, periodic rewiring and tooth cleaning of the inside of my teeth, replacement of any accidentally detached brackets and finally, warning me if he thinks that continued use of the orthodontic jaw wiring may cause harm to me.
     I am fully aware that other methods of weight loss are available to me including: weight loss medicines such as Alli, Meridia and Xenical, Weight Watcher's and Jenny Craig programs and even surgery.
     I understand I am required to make a new appointment for between 4 and 6 weeks after each time Dr. Rothstein rewires my jaws and I realize that I must release the wire {See Release methods]  4-6 days prior to that to permit me to exercise my jaw muscles.  [See jaw joint exercises] I realize that if I do not eat a soft diet during those times that my jaw is unwired I may cause brackets to become detached.
     I have been advised that if I have any conditions which are medically compromising and that demand special medical attention to dietary details such as, to mention just a few: diabetes, gastric reflux, Crohn’s disease, irritable bowel syndrome and malabsorption syndrome, I should not have this procedure done. I have had a medical exam in the recent past and I am in good health and I have no medical problems that may interfere with or be at odds with this procedure. My physician has not advised me to forego this procedure. 
    I have read all the  FAQ's related to OJW and I have especially read the question ,  "Who is NOT a good candidate for the OJW procedure."   I realize the list of reasons for not being a good candidate does not cover every possible condition of ill health.  I am confirming that I am a good candidate and I am providing my initials as acknowledgment in this space X_________ .
     I have been advised that prior to orthodontic jaw wiring I should have a complete physical exam including a complete blood study, and an analysis of my present caloric intake by a registered dietitian [Link to find a registered dietician in the American Dietician’s Association] so that a liquid diet can be designed for my  body type and activity level that is compatible with my weight loss goals.** I realize that while Dr. Rothstein may try to help me with the liquid diet suggestions that it will be my total responsibility to create a liquid diet compatible with my goals. I agree to keep an accurate daily log of my liquid diet showing the calories in each meal and the total of my daily and weekly intake. I agree to show Dr. Rothstein this log at each office appointment. I realize that I may not reach my weight loss goal, but I do not hold Dr. Rothstein responsible since he has not made any guarantee regarding the success of attaining my goal. I realize that exercise is a very important factor in losing weight and that Dr. Rothstein will/has apprise(d) me of the relationship between weight loss and gain and the number of calories and activities I do.
    I realize that extensive vomiting could result in vomitus being taken into my airway, which could be a very serious medical problem requiring immediate medical attention. Consequently, I realize I should immediately remove the wires that hold my teeth together under conditions of suspected or impending nausea. Dr. Rothstein will/has also show(n) me how to remove the wiring with a Nippy wire cutter and even a fork. I have been advised to carry at all times the Nippy wire cutter that Dr. Rothstein gave me.  Dr. Rothstein has told/shown me how to remove the wire in an emergency with a simple fork and shown me that it can be easily accomplished in less than 10 seconds. [SEE INSTRUMENTS AND METHODS OF REMOVING THE WIRE.]  Dr. Rothstein has/will give(n) me his home phone with special instructions to call him if I ever have any problems related to this procedure outside of regular office hours. I acknowledge by my  signature here X_________ that I understand the above.
     I have been told that my speech may be impaired, that Listerine rinses will be the only way to keep the insides of my teeth and mouth clean. I have been told to avoid and/or report any gnashing/bruxing or sideways grinding of my teeth or any jaw muscle aches since they can cause problems to my teeth and jaw joints.
     Dr. Rothstein has prepared me for the uncommon possibility of "panic attack" upon being wired; I may have to release the wiring immediately because I find that my jaws wired closed feel too strange and uncomfortable.
     I understand that the initial wiring fee is non-refundable and that the removal of the wiring and all braces and final cleaning at the last visit will be completed at no charge. I agree to pay a surcharge of $35 for replacing detached brackets after the third one.
     Finally, I permit Dr. Rothstein, if he chooses, to show the chart entries of my case on his website in the "orthodontic jaw wiring for weight loss section." I realize he will respect my right to anonymity. And, I authorize Dr. Rothstein to share my records with other dental, medical and related healthcare professionals concerned with helping the overweight control their problem as part his goal to further the gathering of knowledge about OJW (which is still an experimental method for weight control in obesity) into a national database.
     OJW has not as yet been submitted to the FDA for its approval.  Dr. Rothstein has provided OJW to 125  patients. A utility patent application has been submitted to the USPTO.
     The present fee for OJW is $2685. This fee includes all OJW appointments including removal of the OJW appliance.
I have read and understand this Informed Consent document. Dr. Rothstein has answered all questions to my satisfaction and I affixing my signature to below to indicate that I wish to proceed with OJW
Signature X____________________ Patient’s signature now and again at time of orthodontic jaw wiring; Date :____
INNOVATIONS INTRODUCED TO CONCEPT OFJAW WIRING BY THE AUTHOR
1. The inter-occlusal jaw wiring in OJW has been specifically used toward the goal of weight loss.
2. The jaws are wired in the OJW position of physiologic rest through the medium of orthodontic attachments bonded to the premolars and canines to limit but not totally inhibit mandibular movement vertically, laterally and antero-posteriorly.
3. A robust Informed Consent was created specifically for OJW.
4. A protocol was created which takes cognizance of the possibility of TMJ stiffening over time and the possibility of extrusion of teeth.
5. A study was mounted (N=24) to assess how patients fared following the protocol.
I HAVE PROVIDED OJW TO 125 PATIENTS, all of whom by and large expressed their gratitude in no small terms. If I measured the success of OJW by whether these patients modified their eating and exercise habits permanently then I cannot convincingly say that OJW was a success. I simply did not have the resources to do so. But, if I measure success by gratitude expressed I would have to say they were to the last person pleased with the OJW procedure and the benefits derived there from.
     I am confident that in time OJW will become a service that members of the dental community provide with pleasure in their own communities. I have no doubt that there will never cease to be members of the dental and medical community who look upon OJW with a jaundiced eye. I say offer the service, choose your patients carefully, do the OJW methodically and be responsive to patients needs.      Most of the compulsively overweight will applaud your efforts to help them and they will not hold it against you if they regain the weight. They do expect you would-be providers to see to it that no harm is coming to them because of the OJW. You need to make sure their teeth, gums and jaw joints are not being harmed and to remove the appliance when they request it, and even before that if you think no benefit is being derived.
 

PHOTO-DOCUMENTATION OF THE OJW PROTOCOL FOR TWO CASES:  http://www.drted.com/OJW Two Cases.htm
FREQUENTLY ASKED QUESTIONS REGARDING OJW:  http://www.drted.com/index.html.bak2/jaw_wiring.htm

FREE ONLINE COURSE FOR ORTHODONTIC JAW WIRING:  http://www.drted.com/OJW DPOJW Course.htm
OJW YOUTUBE VIDEOS PARTS 1 AND 2:  http://www.youtube.com/user/drteddrted
OJW Round Table discussion in Orthodontic Products Magazine, February, 05:  http://www.drted.com/OJW Roundtable article OPM PDF.pdf
OJW POWER-POINT PRESENTATION:  http://www.drted.com/OJW DPOJW  PPP.ppt  (note there are two spaces between DPOJW and PPP).
AJODO MANUSCRIPT UPON WHICH PRESENTATION IS BASED:  http://drted.com/OJW AJO-DO manuscript 020509.htm
OJW INFORMED CONSENT:  http://www.drted.com/index.html.bak2/Jaw wiring Informed Cconsent.htm
OJW SAFETY AND EFFECTIVENESS QUESTIONNAIRE SURVEY:  http://www.drted.com/ojw_questionnaire_survey.htm

OJW WITHIN THE SCOPE OF DENTISTRY IN YOUR STATE?: http://www.drted.com/AAO OJW Scope of dentistry.htm

AAO OJW 2010 PowerPoint Presentation:  Available upon request (drted35@aol.com)